Question: I am really embarrassed to write to you, but I don’t really know where to turn. I have been with my husband for over 25 years and we are happy, but in the past six months sex has become painful. It hurts so much that we have to stop. To be honest, I now don’t want to even try. What can I do?
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Answer: I am sorry to hear this and also sorry that you don’t know where to turn. Sex is an important part of life and we need to be able to have open conversations about it, so please do discuss this with your GP.
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Dyspareunia is the medical term for painful sex, and it absolutely is not something you should put up with. Doctors tend to split dyspareunia into two categories: superficial dyspareunia, where the pain is felt in the vulva or vagina, and deep dyspareunia, where the pain is felt higher up in the pelvis or tummy.
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There are lots of reasons why sex can be painful, so your GP is likely to take your history as well as offering an examination. During arousal lubrication is produced in the vagina, which is important. Genitourinary syndrome of menopause can affect the tissues of the vulva, vagina and urinary tract, leading to symptoms such as a dry, itchy, sore vagina and painful sex. This can be treated with lubricants, vaginal moisturisers and vaginal oestrogen. Other causes of vaginal dryness include breastfeeding, hormonal contraception or thrush. The vagina and vulva can also be affected by skin conditions such as eczema and lichen sclerosus.
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Vaginismus can lead to pain during sex, or make penetration impossible. Here, there is involuntary spasm of the vagina, which then makes penetration painful. Treatment involves lubricants, relaxation techniques and vaginal dilators.
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Pain felt deeper in the pelvis or tummy during intercourse can be due to sexually transmitted infections, such as chlamydia and gonorrhoea. It can also be due to conditions such as endometriosis, large cysts or fibroids or even gynaecological cancers. There are lots of causes, but lots of treatment options!
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Pain during sex is never something to put up with
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